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For the last 80 years the term ‘negative therapeutic reaction’ has been used by psychoanalysts and psychotherapists to define the phenomenon of improvement followed by deterioration of a client's psychological or symptomatic condition, apparently in response to their therapist's interventions. Negative therapeutic reaction has been the subject of many papers written by these practitioners, who in various ways have attempted to clarify and understand what goes wrong in such therapeutic encounters.
This paper summarises the ideas of many psychoanalytic writers and practitioners who have worked throughout the span of the twentieth century, and up to the present day. Various aspects of negative therapeutic reaction are explored, such as alternative definitions of the concept, possible origins of NTR, the impact of the therapeutic relationship, and treatment implications. These ideas are compared and discussed, drawing mainly on the object relations theories of Fairbairn (1943), and illustrated through examples from myth, literature, research and clinical vignettes.